Oregon needs nearly $500 million in additional Medicaid funding in its next budget. How did we get here? How do we get out?

This shortfall is no surprise. The Affordable Care Act kindly promised to pay 100 percent of the extra bill to states that expanded Medicaid. Oregon accepted and promptly enrolled 386,000 new patients, all paid for by the federal government.

But that federal subsidy drops to 94 percent in 2017 and to 90 percent in 2020. Oregon’s new share represents an extra $369 million annually, which we don’t have. In five years, that share is $500 million, and we don’t have that either.

How will Oregon fund an extra $500 million — each year — to pay our Medicaid bill?